None listed
Conditions
Brief summary
ADHD is an impairing neurobiological disorder affecting over 300,000 young people in Australia. Up to 70% of children with ADHD experience sleep problems which contribute to substantially worse functioning. A number of studies have now demonstrated that sleep problems are amenable to intervention in young children with ADHD, with large improvements in sleep and child and family wellbeing. This study will extend this program to adolescents with ADHD given that sleep problems continue to be prevalent in adolescents are associated with poorer wellbeing. We recently completed a small pilot randomised controlled trial (DUHREC 2018-135) of a sleep intervention for adolescents (N=11) which demonstrated that the intervention is feasible to deliver to adolescents and their parents. We will now conduct a novel RCT to efficacy of the adapted Sleeping Sound intervention in adolescents aged 13-16 years with ADHD. It is hypothesised that compared to families in the usual care group, adolescents and parents in the intervention group will experience improved outcomes at 3 months post-randomisation for the following: 1. Adolescent sleep problems and sleep hygiene 2. ADHD symptom severity in adolescents 3. Adolescent wellbeing (i.e., mental health and quality of life) 4. Parent mental health
Interventions
The intervention is an adolescent adaptation of the Sleeping Sound Program, a behavioural sleep intervention, which has been evaluated with young children with ADHD and sleep problems (Hiscock et al., 2015; Sciberras et al., 2017). The program has been adapted to include modules that are relevant to the sleep problems experienced by adolescents with ADHD. Intervention materials will include: (1) a sleep diary for adolescent participants to complete, (2) information handouts about normal sleep, sleep cycles and healthy sleep strategies and (3) further information (via handouts) regarding specific sleep difficulties that may be relevant to the adolescent participant (e.g., insomnia, delayed sleep phase). These handouts have been specifically designed for this study. The program will include two 50-minute face-to-face sessions, held a fortnight apart and a follow-up phone call to both adolescents and their parents a fortnight later. The intervention will be provided individually to each family. The intervention will be delivered by study psychologists trained in the intervention by principal investigator and clinical psychologist Dr Emma Sciberras and supported by the investigator team. Face-to-face sessions will take place at Deakin University. Intervention Procedures: The first session will focus on an assessment of the adolescent’s sleep problem, providing information about normal sleep and sleep cycles, giving the adolescent a sleep diary to complete, advice about healthy sleep practices, and a plan specifically tailored to the adolescent’s sleep problem. The second session will include a review of the sleep diary, re-enforcement/trouble shooting of existing strategies and the introduction of new strategies where appropriate. Adolescents and their parents will be called a fortnight later to again monitor progress and offer any final strategies. Treatment fidelity will be maximised and assessed through: (1) fortnightly supervision meetings with clinicians led by principal investigator and clinical psychologist, Dr Emma Sciberras and (2) a standardised consultation record form to be kept by clinicians for each session including the presenting sleep diagnosis, medication use, comorbidities, and treatment progress. References: Hiscock, H., Sciberras, E., Mensah, F., Gerner, B., Efron, D., Khano, S., & Oberklaid, F. (2015). Impact of a behavioral sleep intervention on ADHD symptoms, child sleep and parent health: a randomized controlled trial. BMJ, 350, h68. Hiscock H, Mulraney M, Heussler H, Rinehart N, Schuster T, Grobler AC, Gold L, Bohingamu Mudiyanselage S, Hayes N, Sciberras E. Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster-randomized, translational trial. J Child Psychol Psychiatry 2019; 60:1230-1241. Sciberras E, Mulraney M, Mensah F, Efron D, Oberklaid F, Hiscock H. Sustained impact of a sleep intervention and moderators of treatment outcome for children with ADHD: A randomized controlled trial. Psychological Medicine 2020; 50: 210-19.
Sponsors
Deakin University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
13 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
1. Adolescent has been previously diagnosed with ADHD and currently meets DSM-5 criteria for ADHD as assessed using the ADHD Rating Scale IV. During the screening interview parents will be administered the ADHD Rating Scale and asked to rate their adolescent's behaviour when not on stimulant medication. As per DSM 5 criteria, parents will need to endorse at least 6/9 Inattention and/or 6/9 Hyperactivity/impulsivity symptoms, symptom duration of at least 6 months, age of onset prior to 12 years, and evidence of impairment across settings. 2. Both parent AND adolescent report that the adolescent has a mild, moderate or severe sleep problem that fulfils criteria for chronic insomnia disorder and/or delayed sleep-wake phase disorder according to the American Academy of Sleep Medicine, International Classification of Sleep Disorders (3rd Edition). Adolescent participants currently taking melatonin, as well as any other medications (SSRI’s etc.), will be included in the trial if they continue to meet the above eligibility criteria.
Exclusion criteria
1. Adolescents with a major medical condition (e.g., cerebral palsy, Fragile X disorder) 2. Adolescents with obstructive sleep apnoea. 3. Adolescents with an intellectual disability. 4. Adolescents with current suicidality, psychosis or mania 5. Adolescents who are currently receiving psychosocial treatment for their sleep difficulties. 6. Non-English speaking families.
Outcome results
None listed